What causes vaginismus?

For most women, vaginismus comes as a surprise—difficulties with penetration or ongoing vaginal tightness and pain seem to start mysteriously and continue repeatedly. It is frustrating when our bodies don’t respond the way we want, and it can be so difficult to explain.

The involuntary tightness itself is caused by an internal repeating limbic reaction starting in the brain and extending to the pelvic region. The contributing factors to this reaction are often subtle and complex.

Some clinicians describe vaginismus as a fight or flight reaction in the pelvic floor and surrounding musculature. The muscles are not permanently tightened—they tighten when the limbic system sounds the alarm, then return to normal when the concern is over.

Limbic Reaction



Q: Could vaginismus be my fault?

A: With vaginismus, a woman does not intentionally “cause” or direct her body to tighten and cannot simply make it stop. The muscle tightness is involuntary—without conscious control.

What causes the limbic reaction—to brace and protect?

When the sensory system detects various forms of touch, pelvic vulnerability, or the anticipation of penetration, the limbic system signals the body to tense up internally as a protection mechanism.

It mistakenly alerts the body to danger, causing the vaginal muscles to tighten and, thus, interfere with sex. Not only that, but may also terminate the feelings and buildup of sexual arousal. It repeats in a perpetual, ongoing basis until the problem is properly treated and resolved.

Cycle of Pain

What actually is a limbic reaction?

The limbic system is a group of structures in the brain. They work together to help regulate...

  • Memories
  • Arousal
  • Emotions
  • Reactive body functions

What causes the limbic system to respond in unhelpful ways?

Though normally very effective, life experiences may be internalized in a way that causes the limbic system to respond with vaginismus.

Experiences and events influencing the limbic system’s overreaction


Fear, Anxiety, Shame, or Embarrassment

  • Fear of pain (sex will hurt)
  • Not feeling ready for sex
  • Fear the vagina is too small
  • Fear of hymen breaking, tearing
  • Fear of pregnancy
  • Anxiety about being vulnerable, being seen naked
  • General negativity towards sex
  • Worried about peeing
  • Performance/general anxiety

Prior Experiences

  • Poor sex experiences from insufficient lubrication and/or foreplay
  • Repeatedly painful sexual attempts
  • Overly rigid parenting experiences as a child
  • Unbalanced religious teaching about sex
  • Inadequate sex education
  • Early exposure to pornography or graphic stories
  • Difficult pelvic exam
  • Difficult labor experience/fear of not being completely healed
  • Frustration from failed tampon insertion

Partner Issues

  • Distrust
  • Dislike of partner, uncertainty about the relationship
  • No foreplay, insufficient arousal
  • Fear of losing control
  • Fear of commitment
  • Rough sex

Medical Issues

  • Vaginal atrophy/hormonal changes/menopause
  • Pelvic medical conditions
  • Pain from cancer, cancer treatment
  • Lichen sclerosus
  • Vulvodynia/vestibulodynia
  • Yeast infections
  • Temporary sexual discomfort

Physical/Emotional Trauma

  • Surgery or other pelvic trauma condition
  • Rape/assault
  • Witness of violence or abuse of others
  • Past sexual or emotional abuse


  • No apparent emotional or physical issues. Vaginismus does not always have an obvious cause. Sometimes women with near-perfect childhoods, great relationships, no physical problems, and few anxieties, have trouble identifying a trigger to their vaginismus. The cause might remain a mystery even after vaginismus is fully resolved.

Overcoming the Limbic Reaction

Fortunately, vaginismus is fully treatable. Women can gain control over their vaginal muscles and override the limbic system reaction that causes the tightness. Recovery from vaginismus means having unhindered, normal sexual intimacy and pleasure.